Detailed Information

NPI Number 1720153539 has the “Organization” type of ownership and has been
registered to the following primary business legal name (which is a provider name or healthcare organization name) — DR SUMPTER D BLACKMON PA .
The enumeration date of this NPI Number is 11/21/2006.
NPI Numer information was last updated at 02/02/2010.

The provider is physically located (Business Practice Location) at:

321 WHISKEY RUN RD
CAMDEN
, AL
36726-2303
US

The provider can be reached at his practice location using the following numbers:

Phone 334-682-4128Fax 334-682-9151

The provider's official mailing address is:

PO BOX 699
CAMDEN
, AL
36726-0699
US

The contact numbers associated with the mailing address are:

Phone 334-682-4128Fax 334-682-9151

The authorized official registered with the “1720153539” NPI Number
is
DR.
SUMPTER
DUDLEY
BLACKMON
.

The authorized official title (position) is PRESIDENT.

You can reach the authorized official at the following phone number 334-682-4128.

Scope of Practice

The following information about the speciality of the provider is available:

#

Taxonomy Code

Taxonomy

License Number

License Number State

1

261Q00000X

Clinic/Center

5754

AL

Legacy Identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

The "Is the organization a subpart?" question must be answered. If the organization is a subpart, the Parent Organization Legal Business Name (LBN) and Parent Organization Taxpayer Identification Number (TIN) fields must be completed. The Parent Organization LBN and TIN fields can only be completed if the answer to the subpart question is Yes.
Many organization health care providers who apply for NPIs are not legal entities themselves but are parts of other organization health care providers that are legal entities (the "parents").
Here are three examples of organization health care providers that may be considered subparts and may apply for NPIs if so directed by their "parents":
(1) The psychiatric unit in a hospital is not a legal entity but is part of the hospital (the "parent"), which is a legal entity. The legal entity must obtain an NPI. The psychiatric unit is an example of a subpart that could have its own NPI if the hospital determines that it should.
(2) A group practice that is not a sole proprietorship has a main location and could have other offices in different locations, but each office is not a separate legal entity; instead, each office is part of the corporation (the "parent") which is a legal entity. The offices are examples of subparts that could have their own NPIs if the main location determines that they should.
(3) A pharmacy fills prescriptions for patients whose physicians have prescribed medications for them and may also rent or sell durable medical equipment to patients whose physicians have ordered such equipment for them. Neither the pharmacy line of business nor the DME line of business represent legal entities; instead, both lines of business are part of an organization (the "parent") that is a legal entity. Each line of business represents a different Healthcare Provider Taxonomy or area of specialization that often submits its own electronic claims to health plans.
The "parent"-we don't know who the parent is in this example-must ensure that each subpart that submits its own claims to health plans has its own NPI.

4

Provider Organization Name (Legal Business Name)

DR SUMPTER D BLACKMON PA

Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.

5

Provider First Line Business Mailing Address

PO BOX 699

The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''.

6

Provider Business Mailing Address City Name

CAMDEN

The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''.

7

Provider Business Mailing Address State Name

AL

The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''.

8

Provider Business Mailing Address Postal Code

36726-0699

The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''.

9

Provider Business Mailing Address Country Code

US

The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''.

10

Provider Business Mailing Address Telephone Number

334-682-4128

The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''.

11

Provider Business Mailing Address Fax Number

334-682-9151

The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address fax number''.

12

Provider First Line Business Practice Location Address

321 WHISKEY RUN RD

The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

13

Provider Business Practice Location Address City Name

CAMDEN

The city name in the location address of the provider being identified.

14

Provider Business Practice Location Address State Name

AL

The State or Province name in the location address of the provider being identified.

15

Provider Business Practice Location Address Postal Code

36726-2303

The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.

16

Provider Business Practice Location Address Country Code

US

The country code in the location address of the provider being identified.

17

Provider Business Practice Location Address Telephone Number

334-682-4128

The telephone number associated with the location address of the provider being identified.

18

Provider Business Practice Location Address Fax Number

334-682-9151

The fax number associated with the location address of the provider being identified.

19

Provider Enumeration Date

11/21/2006

The date the provider was assigned a unique identifier (assigned an NPI).

20

Last Update Date

02/02/2010

The date that a record was last updated or changed.

21

Authorized Official Last Name

BLACKMON

The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.

22

Authorized Official First Name

SUMPTER

The first name of the authorized official

23

Authorized Official Middle Name

DUDLEY

The middle name of the authorized official

24

Authorized Official Title or Position

PRESIDENT

The title or position of the authorized official

25

Authorized Official Name Prefix Text

DR.

Authorized Official Name Prefix Text

26

Authorized Official Credential Text

M.D.

Authorized Official Credential Text

27

Authorized Official Telephone Number

334-682-4128

The 10-position telephone number of the authorized official.

28

Healthcare Provider Taxonomy Code #1

261Q00000X

The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.

29

Healthcare Provider Taxonomy 1

Clinic/Center

Healthcare Provider Taxonomy #1

30

Provider License Number 1

5754

Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.

31

Provider License Number State Code 1

AL

Provider License Number State Code #1

32

Healthcare Provider Primary Taxonomy Switch 1

Y

Primary Taxonomy:

X - The primary taxonomy switch is Not Answered;

Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);

N - The taxonomy is not the primary taxonomy.

33

Other Provider Identifier 1

C71994

Other Provider Identifier #1

34

Other Provider Identifier Type 1

MEDICARE UPIN

Other Provider Identifier Type #1

35

Other Provider Identifier State 1

AL

Other Provider Identifier State #1

36

Other Provider Identifier 2

000000454

Other Provider Identifier #2

37

Other Provider Identifier Type 2

MEDICARE ID-TYPE UNSPECIFIED

Other Provider Identifier Type #2

38

Other Provider Identifier State 2

AL

Other Provider Identifier State #2

39

Other Provider Identifier 3

000000454

Other Provider Identifier #3

40

Other Provider Identifier Type 3

MEDICAID

Other Provider Identifier Type #3

41

Other Provider Identifier State 3

AL

Other Provider Identifier State #3

Driving Directions to “DR SUMPTER D BLACKMON PA ” Practice Location

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Practice Location

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